| NPI | 1043465560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2370) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS002590L) |
| 207Q00000X Family Medicine (Licence: OH 1884) | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2008-12-19 |